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Provisions that Help Children and Families

On March 23, 2010, President Obama signed the Affordable Care Act. The law puts in place comprehensive health insurance reforms that will roll out over four years and beyond. Certain key provisions within the law are designed to help children and families by providing free preventive services, extending coverage for young adults, and prohibiting the denial of coverage of children under the age of 19 with pre-existing conditions. To learn about these and other provisions that help children and families use the links below. For a comprehensive list of key features of the Affordable Care Act by year visit: http://www.healthcare.gov/law/timeline/full.html.

Provisions in Effect

Effective April 1, 2010: Allowing States to Cover More People on MedicaidStates will be able to receive federal matching funds for covering some additional low-income individuals and families under Medicaid for whom federal funds were not previously available. This will make it easier for states that choose to do so to cover more of their residents. Learn more about Medicaid.

Effective July 1, 2010: Providing Access to Insurance for Uninsured Americans with Pre-Existing ConditionsA Pre-Existing Condition Insurance Plan (PCIP) provides new coverage options to individuals who have been uninsured for at least six months because of a pre-existing condition such as diabetes or mental illness. States have the option of running this new program in their state. If a state has chosen not to do so, a plan has been established by the Department of Health and Human Services in that state. This program serves as a bridge to 2014, when all discrimination against pre-existing conditions will be prohibited. Learn more about the Pre-Existing Condition Insurance Plan.

Effective September 23, 2010: Extending Coverage for Young AdultsUnder the new law, young adults are allowed to stay on their parent’s plan until they turn 26 years old. (In the case of existing group health plans, this right does not apply if the young adult is offered insurance at work.) Check with your insurance company or employer to see if you qualify. Learn more about coverage for young adults.

Effective September 23, 2010: Providing Free Preventive CareAll new plans must cover certain preventive services such as counseling to help treat depression and reduce alcohol use, as well as other services such as regular well-baby and well-child visits, from birth to age 21 without charging a deductible, co-pay or coinsurance. Learn more about preventive care benefits.

Effective September 23, 2010: Prohibiting Insurance Companies from Rescinding CoverageIn the past, insurance companies could search for an error, or other technical mistake, on a customer’s application and use this error to deny payment for services when he or she got sick. The new law makes this illegal. Learn about how the law curbs insurance cancellations.

Effective September 23, 2010: Eliminating Lifetime Limits on Insurance CoverageUnder the new law, insurance companies are prohibited from imposing lifetime dollar limits on essential benefits, like hospital stays. Learn about how the law eliminates lifetime limits.

Effective September 23, 2010: Regulating Annual Limits on Insurance CoverageUnder the new law, insurance companies’ use of annual dollar limits on the amount of insurance coverage a patient may receive is restricted for new plans in the individual market and all group plans. In 2014, the use of annual dollar limits on essential benefits like hospital stays will be banned for new plans in the individual market and all group plans. Learn about how the law regulates annual limits.

Effective September 23, 2010: Prohibiting Denying Coverage of Children Based on Pre-Existing ConditionsThe new law includes new rules to prevent insurance companies from denying coverage to children under the age of 19 due to a pre-existing condition such as mental illness. Learn how the law protects children with pre-existing conditions.

Effective 2010: Payments for Rural Health Care ProvidersToday, 68% of medically underserved communities across the nation are in rural areas, and these communities often have trouble attracting and retaining medical professionals. The law provides increased payment to rural health care providers to help them continue to serve their communities. Learn more about Rural Americans and the Affordable Care Act.

Effective October 1, 2011: Increasing Access to Services at Home and in the CommunityThe new Community First Choice Option allows states to offer home and community based services to disabled people through Medicaid rather than institutional care in nursing homes. Learn more about the Community First Choice Option.

Provisions Not Yet in Effect

Effective January 1, 2013: Improving Preventive Health CoverageTo expand the number of Americans receiving preventive care, the law provides new funding to state Medicaid programs that choose to cover preventive services for patients at little or no cost.

Effective January 1, 2013: Increasing Medicaid Payments for Primary Care DoctorsAs Medicaid programs and providers prepare to cover more patients in 2014, the Act requires states to pay primary care physicians no less than 100% of Medicare payment rates in 2013 and 2014 for primary care services. The increase is fully funded by the federal government. Learn how the law supports and strengthens primary care providers.

Effective October 1, 2013: Additional Funding for the Children’s Health Insurance Program (CHIP)Under the new law, states will receive two more years of funding to continue coverage for children not eligible for Medicaid. Learn more about CHIP.

Effective January 1, 2014: Increasing Access to MedicaidAmericans who earn less than 133% of the poverty level (approximately $14,000 for an individual and $29,000 for a family of four) will be eligible to enroll in Medicaid. States will receive 100% federal funding for the first three years to support this expanded coverage, phasing to 90% federal funding in subsequent years. Learn more about Medicaid.

Effective January 1, 2014: No Discrimination Due to Pre-Existing Conditions or GenderThe law implements strong reforms that prohibit insurance companies from refusing to sell coverage or renew policies because of an individual’s pre-existing conditions. Also, in the individual and small group market, it eliminates the ability of insurance companies to charge higher rates due to gender or health status. Learn more about protecting Americans with pre-existing conditions.